The characteristics of echocardiographic dilated cardiomyopathy according to its etiologic factors were studied from June, 1984 to September, 1986 in Pusan national University Hosptial. The cases included in the study were 144 patients, 90 cases of male and 54 cases of female respectively ranging the age from 17 years old to 79 years old. Patients with valvular heart disease were excluded in this study. The results were as follows: 1) Primary dilated cardiomyopathy was 40.3%, and secondary dilated cardiomyopathy was 59.7% of the study group. In secondary dilated cardiomyopathy, its etiologic factors were hypertension 17.4%, ischemic heart disease 27.8%, thyrotoxicosis 5.6%, chronic renal failure 4.8%, pregnancy 3.4% and alcohol drinking 0.7%. 2) Atrial fibrillation was noted in 32.6% of primary, 36.0% of hypertensive, 30.0% of ischemic and 62.5% of toxic cardiomyopathy. Conduction disturbance was noted in 57.1% of uremic cardiomopathy, it was far more frequent comparing with other cases of cardiomyopathy ranging 20-30%. 3) The frequency of end-diastolic internal dimension of left ventricle over 6.0cm was 58.6% in primary, 68.0% in hypertensive, 75.0% in ischemic, 71.4% in uremic and 40.0% in postpartum cardiomyopathy. 4) The frequency of ejection fraction of left ventricle below 40% was 17.2% in primary, 8.0% in hypertensive, and 28.2% in ischemic cardiomyopathy. 5) The paradoxical motion of anteroseptal wall of left ventricle was observed in 6.9% of primary, 4.0% of hypertensive, and 17.5% of ischemic cardiomyopathy. The ratio of anteroseptal wall motion to posterior wall motion below 0.4 was 15.6% in primary, 20.0% in hypertensive, and 25.0% in ischemic cardiomyopathy. 6) The frequency and grade of mitral regurgitation became increased with the dilatation of left ventricle. 7) The follow-up of cardiothoracic ratio was helpful significantly in the prediction of prognosis.
Adolescent ; Aged ; Alcohol Drinking ; Atrial Fibrillation ; Busan ; Cardiomyopathies ; Cardiomyopathy, Dilated* ; Dilatation ; Echocardiography* ; Female ; Follow-Up Studies ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Hypertension ; Kidney Failure, Chronic ; Male ; Mitral Valve Insufficiency ; Myocardial Ischemia ; Postpartum Period ; Pregnancy ; Prognosis ; Thyrotoxicosis

BACKGROUND: Despite improvement of mortality in acute myocardial infarcrtion, high mortality rate associated with cardiogenic shock remains essentially unchanged. We have reviewed our result of coronary intervention in 15 patients and found relative survival advantage. METHODS: Between Sep. 1992 and Aug. 1995, 15 consecutive patients(M. 10, F. 5) with cardiogenic shock in acute myocardial infarction were treated with coronary intervention using ballon PTCA. IABP was inserted in all patients prior to PTCA. RESULTS: 1) Most commonly found infarct related artery was left anterior descending artery(11) followed by right coronary artery(3) and left main coronary artery(1). 2) Successful reperfusion rate was 86.7%(13/15), and in-hospital mortality rate was 26.7%(4/15). 3) In-hospital mortality was higher in elderly patients compared with less than 70yaer old patients(0%(0/11)vs. 75.0%(3/4)(P < 0.05). 4) Mortality rate was lower in single vessel disease than multivessel disease(11.1%(1/9) vs. 50%(3/6) p<0.05). CONCLUSION: Although this study is uncontrolled, the date suggest that urgent coronary intervention for improving coronary perfusion may reduce mortality of acute myocardial infarction complicated by cardiogenic shock, particularly with single vessel disease and young age group.
Aged ; Arteries ; Hospital Mortality ; Humans ; Mortality ; Myocardial Infarction* ; Perfusion ; Reperfusion ; Shock, Cardiogenic*

Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in peritoneal dialysis (PD) patients. We report a case of peritonitis due to Chryseobacterium meningosepticum, which was treated successfully with intraperitoneal (IP) vancomycin and ciprofloxacin, and without PD catheter removal. Peritonitis was developed in a 53-year-old PD patient on the third hospital day. Although empirical IP treatment with cefazolin and tobramycin was initiated and maintained for 3 days, the fever and signs of peritonitis persisted. Antibiotics were changed to cefoperazone/sulbactam, amikacin, and vancomycin due to clinical deterioration. After 3 days of vancomycin use, leukocyte count in PD fluid was less than 100/mm3 and the patient became asymptomatic. On seventh day after the onset of peritonitis, Chryseobacterium meningosepticum was isolated from initial dialysate sample, and this strain was susceptible to ciprofloxacin, piperacillin, and piperacillin/tazobactam. Accordingly, we changed the antibiotics to ciprofloxacin and vancomycin, which were given for the total of 14 days. Even though Chryseobacterium meningosepticum is an uncommon causative organism of peritonitis in PD patients, this report suggests that vancomycin and ciprofloxacin are effective as empiric therapy, and early suspicion and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to Chryseobacterium meningosepticum without catheter removal.
Amikacin ; Anti-Bacterial Agents ; Catheters ; Cefazolin ; Chryseobacterium ; Ciprofloxacin ; Fever ; Humans ; Leukocyte Count ; Middle Aged ; Peritoneal Dialysis ; Peritonitis ; Piperacillin ; Sprains and Strains ; Tobramycin ; Vancomycin

STUDY DESIGN: A rectrospective study of microscopic lumbar decompressions was performed elderly patients suffering from multiple level of lumbar stenosis. OBJECTIVES: The Purpose of this study were to assess the outcome of this procedure performed only microscopic decompression on multiple lesions in 5 years follow up and to identify the clinical features of the elderly patients with multiple stenosis. SUMMARY OF BACKGROUND DATA: There was a common to perform fusion and instrumentation in spinal stenosis surgery, because of extensive decompression and instability. However the introduction of microscope in spine operation can minimize lesions and the incidence of spinal fusion. MATERIALS AND METHODS: Twenty-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years. The follow up period was more than 5 years. The clinical results was evaluated by Low-Back Outcome scale. RESULTS: Ten cases were above good results in two levels involved 14 cases, 4 cases above good results in three levels involved 6 cases, one case above good results in four levels. In the cases of affected duration, 4 of 5 cases in less than 1 year, 8 of 12 cases in 1 to 5 years, 3 of 4 cases in more than 5 years were above good results by the criteria. We had calculated the average score (54.8) and concluded that the long-term outcome of decompressive surgery in the elderly is good. CONCLUSION: Selective microscopic decompression is one of the effective method for the elderly patients or patients with osteoporosis in addition to multiple stenotic lesions. And preoprative root block is also useful for selective microscopic decompression.
Aged ; Arthrodesis ; Constriction, Pathologic ; Decompression* ; Follow-Up Studies* ; Humans ; Incidence ; Osteoporosis ; Spinal Fusion ; Spinal Stenosis* ; Spine

The change of venous capacitance has an influence on venous return to the heart and cardiac output, and causes the alteration of preload, cardiac filling pressure and myocardial wall tension. Venous capacitance is assesed by measuring the mean circulatory filling pressure (MCFP), and MCFP is measured during brief periods of circulatory arrest produced by inflating an indwelling balloon in the right atrium It is important to know the effects of vasodilator and anesthetic drugs on venous capacitance. Therefore, this study was performed to know the effects of nitroglycerin and diltiazem on venous capacitance in rats. Rats were anesthetized with ketamine 125 mg/kg given intraperitoneally and added 10 mg/kg every 30 minutes. Their mean arterial pressure (MAP) was lowered to 60 mmHg by intravenous injection of 0.82+/-0.36 mg/kg nitroglycerin and/or 6.7+/-1.5 mg/kg diltiazem. Hemodynamic parameters such as MAP, heart rate, central venous pressure and MCFP were measured before and after drug-injection. Hemodynamic values measured before drug-injection in two groups were little differences statistically. However, the MCFP of nitroglycerin was significantly decreased (p<0.01) from 7.3+/-0.61 mmHg to 5.4+/-0.58 mmHg after drug-injection, and that of diltiazem was not significantly changed from 7.1+/-0.54 mmHg to 6.9+/-0.63 mmHg. The results suggested that nitroglycerin was predominantly a venous dilator in terms of MCFP but diltiazem had little effect of venodilation.
Anesthetics ; Animals ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Diltiazem* ; Equidae ; Heart ; Heart Atria ; Heart Rate ; Hemodynamics ; Injections, Intravenous ; Ketamine ; Nitroglycerin* ; Rats*

A 72-year-old diabetic male patient with high grade fever, right upper quadrant abdominal pain and Klebsiella pneumoniae septicemia is reported. He suffered from high fever and abdominal pain in spite of aspiration of liver abscess and antibiotic treatment. A few days later, we found a palpable pulsating abdominal mass on physical examination. Computed tomography and angiography revealed infected abdominal aortic aneurysm associated with pyogenic liver abscess. He was treated by antibiotics and Endovascular stent without surgical resection. He improved without complications and has been followed-up after discharge with excellent condition. To our knowledge, this is the first case of infected abdominal aortic aneurysm as a septic metastatic lesion secondary to liver abscess.
Abdominal Pain ; Aged ; Aneurysm, Infected ; Angiography ; Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal* ; Fever ; Humans ; Klebsiella pneumoniae ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Physical Examination ; Sepsis ; Stents*

PURPOSE: The purpose of this study is to investigate the role of fibroblast growth factor receptor 4 (FGFR4) polymorphism in esophageal cancer after chemoradiotherapy (CRT). MATERIALS AND METHODS: Peripheral blood samples from 244 patients treated with CRT for esophageal squamous cell carcinoma were assessed for the role of FGFR4 genotype on treatment response and survival. RESULTS: A total of 94 patients were homozygous for the Gly388 allele, and 110 were heterozygous and 40 homozygous for the Arg388 allele. No significant association was found between the FGFR4 genotype and clinicopathological parameters. However, patients carrying the Gly388 allele showed a better overall response rate than Arg388 carriers (p=0.038). In addition, Gly388 allele patients at an earlier stage showed better overall survival (OS) and progression-free survival than Arg388 carriers. Among these, the Gly388 allele showed significantly improved OS compared to Arg388 carriers in the lymph node (LN) metastasis group (p=0.042) compared to the no LN metastasis group (p=0.125). However, similar survival outcomes were observed for advanced-stage disease regardless of genotype. CONCLUSION: This result suggests that the role of FGFR4 Gly388 in treatment outcomes differs according to esophageal cancer stage. It showed a predictive role in the response of esophageal cancer patients to CRT with a better trend for OS in Gly388 than Arg388 carriers in the early stages. In particular, LN-positive early-stage patients carrying the Gly388 allele showed improved OS compared to those carrying Arg388.
Alleles ; Biological Markers ; Carcinoma, Squamous Cell* ; Chemoradiotherapy* ; Disease-Free Survival ; Esophageal Neoplasms ; Genotype ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Receptor, Fibroblast Growth Factor, Type 4

Hypoglossal nerve palsy is a rare and also a multietiological disease. Nearly half of the 12th nerve palsies were caused by tumors and only 5% followed by surgery, usually after head and neck surgery such as carotid endarterectomy. In the reported cases, complications of oral intubation, bronchoscopy and use of laryngeal mask airway can be the causes of hypoglossal nerve palsy and the positional change of neck can be the cause of nerve injury. Using the Beach chair position for arthroscopy of the shoulder has the advantages of reducing traction injuries to the brachial plexus but also the possibilities of complications such as air embolism, complete airway obstruction and nerve injury. We report a case of transient hypoglossal nerve palsy after general anesthesia, using orotracheal intubation, for shoulder arthroscopic surgery in beach chair position.
Airway Obstruction ; Anesthesia, General* ; Arthroscopy ; Brachial Plexus ; Bronchoscopy ; Embolism, Air ; Endarterectomy, Carotid ; Head ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Intubation ; Laryngeal Masks ; Neck ; Paralysis ; Shoulder* ; Traction

BACKGROUND: Antihypertensive treatment represents the modification of one of the most important risk factors on the development of cardiovascular, cerebrovascular and peripheral vascular disease. In cases of markedly developed atherosclerosis, reduction of blood pressure can improve the survival of patients by reducing the incidence and/or severity cerebrovascular events. We studied a new dihydropyridine calcium antagonist isradipine to evaluate the efficacy and safety in patients with essential hypertension. METHOD: After a placebo run-in phase of four weeks duration, 2.5mg isradipine once daily orally was administered for four weeks to 84 patients (48 males, 36 females ; mean age ; 50.8 years). And then 5.0mg isradipine once daily was administered for four weeks to 59 patients whose diastolic pressure did not decrease less than 90 mmHg. RESULTS: 1) At the end of 8 weeks of therapy, systolic and diastolic blood pressure were significantly reduced from 158.2+/-11.5/101.7+/-5.1mmHg in sitting, 156.8+/-13.7/102.3+/-5.6mmHg in standing to 138.3+/-13.8/90.1+/-6.7mmHg in sitting, 137.6+/-13.7/91.2+/-7.6mmHg in standing (p<0.001). And the effectiveness rate was 84.3% in sitting, 83.2% in standing and normalization rate below 90mmHg in diastolic pressure was 67.5% in siting and 61.5% in standing position. 2) The sitting and standing pulse rate did not change significantly (72.7+/-7.4beats/min at baseline vs. 73.4+/-6.8 beats/min after 8 weeks trial in sitting, 73.5+/-7.2beats/min at baseline vs. 74.1+/-7.2 beats/min after 8 weeks trial in standing). 3) The reduction of mean systolic and diastolic blood pressure at the end of 8 weeks were 19.9/11.6mmHg in sitting and 19.2/11.1mmHg in standing. 4) At the end of 8 weeks the successes of therapy in sitting were 67.5% in excellent, 10.8% in good, and 6.0% in fair response. 5) There was no serious side effect except mild symptom of 5 cases(5.9%) of exertional dyspnea and one episode of (1.2%) tachycardia. CONCLUSION: These results indicate that isradipine is effective and safe antihypertensive agent in the treatment of essential hypertension.
Atherosclerosis ; Blood Pressure ; Calcium ; Dyspnea ; Female ; Heart Rate ; Humans ; Hypertension* ; Incidence ; Isradipine* ; Male ; Peripheral Vascular Diseases ; Risk Factors ; Tachycardia

BACKGROUND: Selective 2-agonists cause decrease in serum K+ concentration. Midazolam is an anxiolytic, sedative, and amnestic drug. Premedication of midazolam prevents increase of catecholamine with anxiety. Clonidine, alpha 2-adrenergic receptor agonist, supresses sympathetic outflow from central nervous system. So we can expect that premedication of clonidine or midazolam will prevent hypokalemia before induction of anesthesia. METHODS: Twenty two patients received 300 mcg clonidine per oral, 22 patients 0.05 mg/kg midazolan IM and 22 patients had no premedication. We measured serum K+ level at out-patient Department (T1), at 11:00 P.M. of the day before surgery (T2) and immediately before induction of anesthesia (T3). RESULTS: Serum K+ levels at T2 decreased compared to serum K+ level at T1 in all groups. Serum K+ levels T3 decreased compared to serum K+ level at T2 in control and midazolam groups but clonidine group did not decrease in serum K+ level. CONCLUSIONS: We can not prevent decrease of serum K+ level with premedication of midazolam but we can prevent decrease of serum K+ level with premedication of clonidine. So premedication of clonidine is more effective than midazolam in prevention of hypokalemia before induction of anesthesia.
Anesthesia* ; Anxiety ; Central Nervous System ; Clonidine* ; Humans ; Hypokalemia* ; Midazolam* ; Outpatients ; Premedication